Definition – when can a couple be defined as infertile?

Infertility is defined as the inability to conceive with regular sexual intercourse without using contraception for
year. Cumulative probability of pregnancy in general population: 84% 1st year, 92% 2nd year and 93% 3rd year.

Is infertility a “women’s problem?”

Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In rest of the cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

How long should we try before we see a doctor?

Experts often advise you not to be concerned unless you have been trying to conceive for at least one year, unless you do not menstruate regularly. However, if you are over 30 years old, have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if your partner has a known low sperm count, it is often recommended by doctors that you may want to seek help sooner. Many couples have a hard time admitting that there may be an infertility problem. After each menstrual period, they hope that “maybe it will work this cycle”. When these hopes are dashed month after month, a woman often consults her regular Ob/Gyn or a fertility specialist.

What is a Fertility Specialist?

A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Ob/Gyn, a Reproductive Endocrinologist must complete highly specialized training for all aspects of infertility.

Infertility – what are the main causes?  

Causes of infertility in women are tubal blockage and/or peritoneal factors, irregular or abnormal ovulation or endometriosis. Causes in men are poor sperm quality or quantity. For some couples no specific cause of infertility can be identified.


Polycystic ovary syndrome (PCOS) is an ovulation disorder. PCOS affects around 4-6% of all women in the reproductive age. We do not exactly know what causes the disease, but genetic factors and environmental factors may contribute to the disease. The main symptoms are irregular menstrual cycles, hirsutism, acne and obesity. To increase the chances of pregnancy, treatment is focused on regulating ovulation.

Causes of damaged fallopian 

Infections caused by sexually transmitted diseases such as chlamydia and gonorrhoea can lead to damages of the tubes. Other causes include septic abortion, ruptured appendix, tubal surgery or tubal pregnancy.

What is endometriosis? 

Endometriosis is the occurrence of endometrial tissue outside the uterus. It is estimated that 3-10% of women in the reproductive age have endometriosis. The major symptoms of Endometriosis are abdominal pain, especially during menstruation and during coitus. While there are many theories to the causes, we still do not know exactly what causes endometriosis or how it affects fertility.

 Infertility after 40 years of age? 

Infertility among women increases with age. Below the age of 31 the pregnancy rate over one year is 74%. This decreases to 62% at ages 31 to 35 and to 54% for women older than 35. It is very difficult to predict the chance of pregnancy for an individual, but research shows that fertility decreases with age due to declining quantity and quality of the woman’s eggs.

What causes recurrent miscarriage?

The incidence of pregnancy loss among all women is about 15%. Recurrent miscarriage affects 1% of all women. Approximately 70% of all early spontaneous miscarriages are associated with fatal chromosomal abnormalities. In most cases, the parents are chromosomally normal and the fatal chromosomal abnormality is a random event.

At what time of the month is a woman most fertile?

The most fertile time of the month is just before or at ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time.

Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32 day cycle would likely ovulate around day 18 (32-14=18), while a woman with a 28 day cycle would ovulate around day 14 (28-14=14).

Because the sperm live longer than the egg does, it is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles, one way to decide on the potential fertile period is by taking the shortest cycle and subtracting 16, then taking the longest cycle and subtracting 12. This would give the fertile time and allow for even more fluctuation in cycle length than usual. For example, the fertile period for a woman whose cycles vary from 27 to 33 days should be sometime between day 11 (27-16=11) and 21 (33-12=21).

Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at drug stores. One important fact to note is that, if a woman is using a basal body temperature chart, that the temperature will rise after ovulation, and therefore after the most fertile period. The couple should therefore not wait until the temperature has risen to start to have intercourse, as they will have missed the most fertile time.

How can a woman tell when she ovulates?

The simple, inexpensive way of finding out the approximate time when you ovulate is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate.

Are there any other ways to detect ovulation?

Yes. You can buy an ovulation predictor urine test at your drug store. Also, your body may signal when you are about to ovulate; many women feel twinges in their lower abdomen (your ovaries are on the right and left sides of your lower abdomen). Other women notice clear, stretchy vaginal discharge just at their fertile time. Your doctor can also request an ultrasound or appropriate blood tests to determine ovulation.

How often should we have intercourse?

It is a good idea to have intercourse every other day around the time you ovulate. (Day 10, 12, 14, and 16.) Remember, every woman is different, and may not ovulate exactly on “Day 14.” And, just because you ovulated on “Day 14” this month, doesn’t mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, it is generally recommended that you do not douche or use lubricants immediately before having intercourse.

What tests might our fertility specialist perform?

Your doctor will likely do the following:

  • Blood tests to check all hormone levels in the woman; thyroid, prolactin, and androgen levels
  • Complete semen analysis on the male partner
  • Hysterosalpingogram (HSG), an x-ray to evaluate if the woman’s fallopian tubes are open
  • Endometrial biopsy, to check the quality of the uterine lining (if appropriate)
  • Laparoscopy, outpatient surgery to check for endometriosis or pelvic scarring in the woman


How is Semen Amalysis done?

The lab will provide instructions to abstain from sex for a certain period of time before the test, and it will give you a small jar to use for the specimen. Generally, after masturbating and ejaculating into the jar, you must take the whole specimen immediately to the lab. You may be asked to produce a specimen at the lab, where they will provide a private room.

What about smoking and drinking alcohol and caffeine?

There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine. Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin. It is wise to be in the best physical shape possible while you attempt to conceive and, of course, to help to ensure a healthy pregnancy and baby.

Are hot tubs really bad for a man?

Yes. High temperatures can kill sperm. That is why the scrotum is located outside the body — to act as a kind of “refrigerator” to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms. Wear loose pants and underwear.

What else can we do?

Learn as much as you can about infertility. Find and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.